The following article appeared in the Chiswick Herald on the 1st February.
Sometimes people with anxiety start to withdraw and avoid things, people and situations where they experience heightened anxiety. Avoidance is a valid coping mechanism and a tool that can facilitate recovery from trauma but if you or someone you know is gradually withdrawing with no decrease in anxiety then maybe its not the most helpful one!
In fact this might be considered as “colluding” with anxiety, and collusion ultimately leads to greater anxiety.
Anxiety is a heightened state that is identifiable through a combination of physical, psychological and behavioural experiences. Anxiety is different to stress in that it is a longer term condition and it is for this very reason that it can be harder to identify and therefore to treat.
It is not uncommon for people to be unaware that they suffer from anxiety until they realise that other people do not feel like them and again, being able to identify anxiety can depend upon its cause. Where there has been a significant life event it can be easier to spot than if someone has been anxious since a very early age. Again it is common for people to not recognise anxiety because the way they experience life has never been any different. For people who have this type of anxiety it can be helpful to think about a persons early years and any childhood traumas.
And of course anxiety is linked to a wide range of other unpleasant experiences such as panic attacks, agoraphobia, other phobia’s, obsessive compulsive disorder etc. Long term anxiety may also result in clinical depression or other mental health conditions - so once recognised it is really important to start developing ways to manage and hopefully recover from anxiety.
Returning to colluding with anxiety, a common experience is for sufferers to be anxious about being anxious and this is contrary to how anxiety can be alleviated. This cycle which can only result in an escalation of the anxiety must first be broken. We need to recognise that the anxiety has a message for us - one that we need to understand and to do this we must adopt a “kindly curiosity” towards the experience of the anxiety.
Imagine someone who cannot travel on the Underground, how might you apply the idea of kindly curiosity? Here are a list of questions that might be helpfully worked through.
- What is the impact on the person of not being able to travel on the Underground? Answers may be practical for example the cost of having to get taxis or more personal for example feeling unhappy with oneself or a combination.
- Has something happened on the Underground? If yes then traumas that have resulted in an unwanted change are something that people take to counselling.
- When did this anxiety first appear?
- Was there anything else going on in life at the time?
- What has been tried to manage or treat the anxiety?
- What hasn’t been tried?
- Have you looked for information on using the underground, anxiety and how other people cope?
- What do you think and feel about what you have found out?
- What would you like to do about it?
- What might you find supportive / helpful?
- Who might you find helpful / supportive?
- Is there any reason why you do not try to deal with this or why it is hard to get help?
- If a person you cared for was in your situation what would you say to them, or how would you help them?
In therapy, one of the approaches to overcome an anxiety linked to a specific situation is firstly to talk it through, secondly to talk about information that might be helpful and then thirdly to draw up a plan of action.
A plan of action in terms of travelling on the Underground will be tailored to the specific person, based upon what they want to do, what has worked for other people and what the therapist and the person senses to be manageable.
For example, the sufferer might first of all watch videos of underground journeys, they might then go to visit an Underground station, then they might take a train just one stop on an overground section before taking longer journeys. They might have a therapist or friend / relative travel with them the first few times, drop them at the station or meet them at the other end. They might take their mobile phone with them and have someone lined up who they can call. They might take a book or listen to music, carry food or water….. As you can see so many options.
The important thing is to be kind, take small steps and listen to what feels manageable.
The Underground is a fairly common example and one that can cause anything from mild to debilitating anxiety. If either yourself or someone you know is struggling with anxiety remember this is a very common problem and it is treatable.
Our latest article on reducing anxiety was published in the Chiswick Herald on page 31.
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Feel happier - reduce stress and anxiety - here’s how!
Stress comes from being under pressure, anxiety comes from prolonged stress, anxiety reduces our happiness - so anything we can do to reduce pressure will have a direct impact on happiness!
In this article I’m going to look at how, by paying attention to our thinking and the words we use to describe things we can become more relaxed, have less conflict with others and become happier. Initially, I will explain how we have a natural tendency towards the negative, the role of our thinking, how the words we use can make things worse for us and then offer an experiment to help you start to make changes. This article will deal with events that we might come across everyday - in the next article we will look at relationships.
When we experience being under pressure the experience is one that is alerted to us by a combination of our feelings, thoughts and bodily sensations. Neuroscience is showing that our feelings are something over which we have very little control - our bodily sensations and feelings will be triggered in response to a perceived threat or pleasure and then our thoughts will try to make sense of what is happening and if it is a threat, to seek a solution.
Under pressure it is our thinking which often proves to be the weak link.
Thinking happens through our language, thoughts are the assigning of words to our experience and the biggest single problem with our language is how it contains so much scope for subjectivity combined with its tendency to see things as either positive or negative.
Being first and foremost concerned with our survival, negative judgements take precedence. For example, when we have a feeling we see as “good” we do not tend to dwell, analyse and procrastinate because there is nothing to be done, we are not under any possible threat. However when we have a feeling that we see as “bad” we naturally tend towards needing to find out what is “wrong”. The issue here is that we are already looking for something “bad” - we are starting with a bias.
Our experience of living may be made up of equally good and bad feelings but the importance given to the bad means the way we can end up looking at the world will be skewed towards the negative.
In addition, the difficulty of feelings that we experience as bad can mean we do not feel as though we have time to understand whether our judgement is correct. Instead our in built risk assessment systems will urge us to think about the worst scenario, draw upon our previous bad experiences and allow our adrenal systems to kick in and allow physiological action designed to save us.
Our very sensitive but not necessarily accurate systems are great for saving us when we really need it - where our safety is at risk - but it also influences us in low risk everyday situations where we find ourselves reacting to things and making negative judgements. I am not saying we stop judging but we recognise when we do this and how it has the potential to make us unhappy.
Here is an everyday example:
Imagine you are walking down the street - you narrowly miss stepping on some dog faeces. Whilst you are pleased you missed it you remember a previous time when you stepped in some dog “mess” and how annoyed you felt and the extra work involved in cleaning your shoes and the entrance hall carpet at home. The word “mess” combined with the previous memory triggers irritation and you think about how “irresponsible” people can be, that reminds you of how you found a new scratch on your car the previous week, you think “vandalism” and now you feel angry but also a little frightened. In turn that fear then reminds you of what you saw on the news about an increase in muggings in another part of the city. Now you think about how the city is changing and how crime is getting worse, how people are “dangerous” and you now feel unsafe.
Instead imagine this possibility:
Walking down the street you narrowly miss stepping in some dog faeces. Whilst you are pleased you missed it you remember a previous time when you stepped in some dog “mess” and how annoyed you felt and the extra work involved in cleaning your shoes and the entrance hall carpet at home.
NOW at this point - at the time of your initial reaction - try to train yourself to pause. You do this so that you can now look at the reaction and look firstly for words which are not purely descriptive - so ones that contain a subjective / judgement - in this case “mess” and secondly look at how this event today is triggering past negative events.
Now, having fully understood how you are reacting in a way that is amplifying the event and its negative impact on you, recall how you were feeling before this happened, take a second or so to fully experience yourself as you were.
Obviously it is unrealistic to expect yourself to do this every time something generates a negative thought and feeling however if you can start to do this occasionally you will start to understand how set backs, surprises, misunderstandings, disappointments etc end up with much more power than they fully warrant and how that can sabotage your happiness. In our next article we will look at how to apply this to relationships.
This month an article appeared in the Chiswick Magazine after Nicholas was interviewed by their Editor Katie Saunders. Please click here to read.
Our latest article has been published in the Chiswick Herald, click here to visit the site or read below.
Here’s how to give yourself a summer mental health and wellbeing check up!
Summer can be a great time to take stock. The disruption in our usual routines can remind us that there are different ways to live and this can be enough to help us make some simple but hugely important changes.
The summer holiday is for many people the one time when they feel they have earned the right to do what they enjoy. As a result it is a time when many things are enjoyed - some of which maybe vital for well being - but how can you decide what is vital and what is merely pleasure for pleasures sake?
It is a natural tendency for us to let the things that support us fall by the wayside at times when the pressure of everyday life demands sacrifices. I use the word sacrifice intentionally because what I see people doing every day is “sacrificing” something. Firstly because there is a hope that some reward will follow and secondly because a sacrifice is mostly seen and understood as positive thing. Everyone has heard something said like “she sacrificed the best years of her live for her children and see how they repay her”, or “he worked for them for years, put up with poor pay and now look at how he’s been treated”. It doesn’t change what has happened but it does position the one who has sacrificed as the one to be judged more sympathetically.
In other words I think people can find themselves leading hard lives because they prefer to think of themselves as someone who sacrifices. And then of course people don’t sacrifice overtime for time with their families, don’t sacrifice promotion for staying in a job they are actually enjoying, don’t sacrifice the rush hour commute in favour of a yoga class, don’t sacrifice the hour they spend each day reading bad news for an hour listening to music, reading, walking, making love… A sacrifice seems to be about giving up something we find positive…
My point is simply that the judgements and beliefs we hold about the way to approach life will affect the way in which we make decisions and not always for the best! So use the summer holidays to give yourself a mental health and wellbeing check up and heres how.
Think about and write down:
1. The things you do during your usual routines that you are pretty certain are unhealthy / unhelpful, the things you would like to change or improve for example, lose weight, drink less, exercise more etc.
2. Your life when you are in your usual routines and without stopping to analyse/censure what comes to mind list the times when you have the most positive feelings/thoughts/bodily sensations.
3. When you get the most negative feelings/thoughts/bodily sensations.
4. How this compares to when you are on holiday.
1 Write down the three most significant things that you DO NOT feel compelled by when on holiday. For example “on holiday I do not feel under pressure to get everywhere on time” again do not stop to analyse or censure.
2. Again without analysing / censuring, write down what would need to be different for example, “I would need to start working part time”.
3. NOW is the time to allow yourself to analyse and censure your reactions to these changes - so list all the reasons why you do not think you can change.
This is the point at which you will see all your judgements and belief’s - ask yourself “what of the things I’ve listed here do I actually know, where does this come from and what evidence do I have that this applies to me and my life?”.
Our latest article has been published in the Chiswick herald can be found here. Or please read below:
A couple of common misconceptions about feelings explored….
Is it wrong to have bad feelings when people die?
At a funeral I went to last year the priest spoke about how loss might bring up sadness, loneliness, depression and shock. The difficulty for me in hearing these feelings listed was that it led me to think that we were being told that only certain feelings are appropriate; ones that suggest we had a relationship with the deceased that was wholly positive?
In reality bereavement can bring up many difficult feelings both about the relationship someone had with a person who has died and the fact that the person has now died, for example, these might include angry, vindictive, hurt, hostile, relieved, excited, numbness etc. It was only at the wake afterwards people appeared to find themselves able to start to acknowledge the more authentic nature of their relationship with the deceased, for example to be able to say something like “I could get so annoyed with her because she used to be so stubborn” or “I could feel so disappointed because she could be so judgemental”. Even then I found myself wondering about other thoughts and feelings that remain “secret”. For example, people can feel relieved when someone dies but then feel guilty that they have that feeling of relief.
As psychotherapists, when counselling we so often have patients where part of the struggle is because they have feelings that they think are wrong or inappropriate. That means we often have to deal with the persons feelings about their feelings before we can start to work on the underlying feelings themselves.
So whats the answer? Firstly to accept that when things happen to us then the feelings, the types of feeling and the strength of feelings or even the absence of feeling are a reaction over which we have no control and no matter what we think of them they are all appropriate and justifiable. It is the actions that we take in response to feelings that can be problematic so instead of being concerned about the feelings and trying to control them, pay attention to them instead, question them, try and understand them and then think about what you would like to do.
Do you ever say (or think) “You are making me feel….”?
This is something that I think most people will find themselves saying at some time or other. For example, that person who you have told numerous times not to be late is late and you say to them (or think) “you are always late and you make me feel so annoyed!”. But of course the annoyance is yours and it is most likely because you have again fallen into the trap of expecting a different outcome? After all it is not really a surprise that they were late. So what is the annoyance? I suggest it is annoyance with yourself and because we like to try and get rid of negative feelings as quickly as possible we can mistakenly expect the best way to deal with them is to allocate them on someone else.
Because our feelings appear so powerfully to us when someone says or does something that generates a reaction, and because it is also usual for others to quickly think we are the source of their feelings, this basic notion is almost hardwired. However this misconception does not help us, because the way in which we respond to people and situations is a uniquely personal thing based upon a range of factors including our life experiences, expectations and cultural norms to name a few. And the proof? Can you say you never witness different people responding differently when in the same situation? It is a common phenomena that when there is an incident, police witness statements typically contain very different accounts of the same incident. And what about all the times when you have found that your explanation of someones behaviour is different to someone else’s?
The reason why this is so important is that you can change your way of thinking so that you see your feelings as YOUR response to a situation or person. And when you do this you can consider what those feelings are telling you about yourself and how you are living your life. Back to that person that is always late, now you are no longer putting the responsibility for your feelings on them what do YOU want to do about avoiding either the situation or the feelings next time?
If you would like to speak to a counsellor for help and advice please don't hesistate to get in touch.
Our latest article is being published in the Chiswick Herald newspaper and online here. Or read below:
Mental Health Round Up
It has been a very busy few weeks in mental health and it is heartening to see so many people agreeing it is time for mental health concerns to shake off stigma. The charity led by the Duke and Duchess of Cambridge and Prince Harry, Heads Together aims to encourage people to speak out when they are struggling.
Of course it is part of our experience of being alive that we have an internal and private world of thoughts and experiences that we do not routinely share with others. So how can we know whether we have a concern which needs attention?
At the present time it still seems that only in certain instances can it be accepted that someone might struggle with their mental health; so people who have experienced life changing trauma or those who through a number of factors are diagnosed with a mental health condition. It is also still a harsh reality that only if someone’s “presentation” fit with a recognised “condition” will their struggle be seen as genuine and treatment be provided through health services. Further with all the gaps still existing in the science around mental health we cannot yet be clear about whether existing treatments are in fact effective treatments.
All so called “mental health conditions” (still widely thought of as illnesses) are not identified by the presence of viruses, bacterias, infections, tumours or fractures etc but rather by observed “experiences”. PTSD, ADHD, Depression, Schizophrenia, Bipolar, Anxiety Disorders, Learning Difficulties etc are all identified through observation and judgement. The authors of the worlds most widely recognised diagnostic publication the DSM (Diagnostic and Statistical Manual of Mental Disorders) have stated that they are concerned that science has not yet been able to validate the categories of conditions it contains.
If you cannot be completely certain about the problem how can you be completely certain about the treatment? And if the treatment is not correct what might the implications be for the patient? For example, in the UK it has been identified that young black men are much more likely than young white men to be diagnosed with schizophrenia and no underlying biological cause has been found. So I think that a system that only treats and recognises “conditions” may be as effective at preventing people seeking and getting help as it is at encouraging treatment.
Indeed in response to my article published on the 24th February “What causes mental illness?” where I reviewed a seminar I had attended based upon a book by RD Laing and Aaron Esterson called Sanity, Madness and the Family, the seminar convenor, Anthony Stadlen wrote:
“I think the title is a bit misleading, as the whole point of the book, as I try to explain in the seminars, was to question "mental illness" and "schizophrenia", not to ask what "causes" them. The very first sentences of the Preface to the Second Edition were:
"There have been many studies of mental illness and the family. This book is not of them, at least in our opinion. But it has been taken to be so by many people."
I think this whole question is really important because the gaps in scientific understanding can mean only one thing - we need to look to ourselves and how we experience our lives and decide whether we need to make changes. So back to the question I posed at the start of this article - “How can we know if we have a mental health struggle that needs attention?” Firstly, if people who you are close to say they are worried about you or have noticed that you do not seem to be your old self then take some time to think about their feedback, ask them to give more detail and if you are unsure whether they might have a point then go and see someone to talk things through with. Secondly, if you wonder whether you are struggling then again go and see someone and talk things through. Be as kind and careful with yourself as you would your best friend!
Our latest article has been published in the Chiswick herald please click here or read below.
Latest advances in treatment of anxiety and depression coming out of the USA
I have just returned from the annual Anxiety and Depression Association of America’s annual conference. The Association is a huge organisation that aims to improve patient care by promoting the implementation of evidence-based treatments and best practices. The focus of this years conference was “wellness” and aimed to present the latest research findings coming from neuroscience and treatment.
I have for some time been interested in what neuroscience is able to tell us about how the brain appears to work differently when there are particular concerns such as anxiety and depression. For example, studies have shown that the practice of mindfulness appears to have a direct impact upon brain activity and the reduction of anxiety. And it is becoming ever clearer that “disorders” occur when there is some disturbance or interruption between the alarm raising part of the brain - (the amygdala) and the processing or thinking area - (the prefrontal cortex). But we still do not know whether the disruption is in the connection from the amygdala to the prefrontal cortex or from the prefrontal cortex to the amygdala; or a combination of the two. It also seems as though opinion is leaning towards the view that such disturbances occur following some kind of “trauma”, either event driven or biological. However this cannot be definitely stated.
In the therapy profession the behavioural community do tend to be more interested in research than practitioners in the other disciplines and so cognitive behaviour therapies or “CBT” have a bigger base of research evidence. As a result service provision organisations like the NHS tend to lean towards offering these services as they are easier to justify from a financial resources perspective and offer monitoring opportunities. Of course the absence of research from other types of therapy proves very little except that those practitioners do not see a need for research.
But research on outcomes from therapy generally conclude that the single most significant factor determining a positive outcome is not the therapeutic model or approach but the quality of the relationship between the patient and the therapist. The major issue here is that researching “relationships” and monitoring them is far more complex than therapeutic tools and techniques and so the focus is unlikely to change any time soon.
My experience tells me that what people need more than anything else is to meet with someone who they feel cares for them and is passionate about wanting to understand their particular concerns. Such an experience is helpful because the person won’t feel the need to justify themselves and can instead think clearly with another person about their situation and what they can do about it. But I also find that people make sense of their situations in different ways, some people are analytical, some clear about their feelings and others like to think through things. When someone is struggling it is likely that they may need to adjust the emphasis they put of the way in which they make sense or not of their problems. Sometimes people ask for CBT and then want to spend their time speaking about their past, whilst others may say they want to talk about how they feel but spend their time looking for solutions. So what does this mean for anyone wanting to seek help with their psychological well being?
- Keep in mind that all mental health conditions have been developed by grouping experiences and are not like physical health conditions that can be diagnosed like viruses, infections or fractures.
- We still don’t know whether conditions are nature or nurture or both
- The expectation of trauma can be misleading and sufferers can fear that their condition must exist because something has happened to them that they have no hope of coping with
- Chose a therapist with whom you feel comfortable - someone with whom you find it easy to speak openly with.
- Remember you are in charge and give feedback to your therapist to ensure you get the best possible outcome.
This article appeared in the Chiswick Herald. Please click here or read below:
Depression - how to think about it and how to recover from it
News reports last week covered research showing that 25% of architecture students in the UK are receiving or have received treatment for mental health problems related to their studies. Unusually this study sought to identify the sources of the distress and was able to list a number of factors - importantly all of these were outside of the students control.
It is often rightly stated that a stigma exists around depression and other mental health illnesses. However the point that often gets missed is that one of the biggest blocks to sufferers in recovery can be their own attitudes to both mental health and themselves for experiencing mental illness. It is really common for people to feel upset with themselves for struggling and to try and almost bully themselves out of their feelings. Unfortunately this tends to result in sufferers feeling even worse and they can become stuck in a vicious cycle of thoughts and feelings.
This research amongst students suggested that financial pressures, workloads, working conditions and sexual and racial discrimination were all serving to damage the mental health of one in four of these students. And as I have written previously, it seems that the mental wellbeing of students and employees in the education sector has been overlooked for some time. So much focus os put on results and processes with little emphasis on wellbeing.
So research like this is really important because it shifts focus when someone is struggling. Instead of questions being raised around how the person is coping (or not coping) with the inference being that they are not doing something right, it can be directed at looking and considering the context in which the person finds themselves.
We know ourselves through our relationships with others and yet when we are having a hard time, it can be really easy to conclude that it is only us that are finding things hard. I wonder just how surprised but also relieved architecture students were when they read the findings of the research? For many I suspect they will have felt intensely relieved, not that so many others struggle but that they are not alone. And more importantly the cause of their depression and anxiety is not simply themselves.
Getting a comprehensive understanding of the issues someone faces and the context in which they live and have come from is crucial in getting to grips with depression. Before anyone can start to recover they need to discover some hope in the potential for them to lead a life without such painful and overwhelming feelings, or as is often the case with depression absence of feeling. And hope comes from the realisation that the depression is only natural given where they find themselves in life, that it is not that they are doing anything wrong but the contrary, that it is only right that given their circumstances they can feel as they do.
Being able to make the connections that makes sense of the experience starts a process whereby positive connections can start to be made. Ways in which the sufferer can start to do things differently, take control, build confidence and distance themselves from the illness and increase their sense of connection with the world, others and their ability to find life satisfying and rewarding.
Again though, during recovery one of the biggest hurdles can be a persons impatience with their recovery. The desire to get away from the experience of depression can be so powerful that they can be vulnerable to almost addictive behaviours. Exercise can be a good example of this, the physiological feelings and rewards available from exercise can lead to addictive behaviour and ultimately this can act to sabotage recovery.
To prevent this it is important to spend time to reflect on whats happening, the changes being experienced and to consider the consequences of decisions moving forwards. It is a common phenomenon that people who appear to be on the point making a full recovery make a decision that can have devastating results. In fact suicide risk can be greatest for people who appear to be in recovery than those in the depth of their depression.
Mental illness is such an unpleasant experience for suffers and their loved ones that it is only natural to try to avoid dwelling on difficult feelings and to want to look forward and focus on the positive however taking time to think about how things are going and how to maintain momentum whilst allowing set backs is crucial.
If you or someone you know is suffering from depression then consider seeking help. A counsellor or psychotherapist will have the right skills and experience to help understand the depression, its causes and then provide support through the entire recovery process.
Patients often ask me how long it will take, how many sessions will be needed for them to recover. My answer is always a simple one - we know we are finished when we no longer have any concerns that are usefully talked through.
Our latest article has been published in the Chiswick Herald, please click here or read it below.
How to make the School Holidays the best ever!
The school holidays are a wonderful opportunity for families to strengthen and improve their relationships and yet for many parents they can bring stress and anxiety. For some parents it can be more about surviving than enjoying the school holidays.
The first thing to remember is that as parents you are in charge and so before anything else take some time to think about how best to manage what can be a massive undertaking in terms of balancing time, logistics, money, competing demands and complex relationships.
Principle one - Look after yourself before looking after others
Priority number one is the well being of the person in charge and yes that is you. So it is really important that you know what you can manage and that you apply your knowledge about what will work best. After all it is you who will have to manage whatever plans are made. Here are a list of questions to help you think about this:-
How are you?
How’s life for you at the moment?
What is concerning you at the moment?
How do you feel about family life?
What would you like to get out of the summer holidays?
Why do you think you want this - is this what you want or need?
Now take a moment to now think what you NEED from the holidays?
What do you not want to happen?
Thinking through how the family is at the moment what do you foresee?
In terms of current challenges what have you tried and what haven’t you tried?
Do you feel supported? Again, if not what have you tried and not tried?
How self critical are you? Yes difficult behaviours in the family may well be coming from the dynamic created by traits that you see as your own shortcomings but be kind to yourself. Don’t make yourself do things because you feel you should - find creative ways to achieve the same aims!
Principle two - Use a constructive and collaborative communication style
Avoid escalation of conflict by simplifying your communication. When you feel that conflict may arise use this four step way of ensuring you express yourself clearly and in a non confrontational way.
- State the fact/s
- Say what your response say how you feel and think (never say you make me feel / think because that will escalate conflict)
- Explain why this matters to you
- Share the problem you now have and ask them for their input
For example one of your children arrives late, this means you will be under pressure to get somewhere on time, this is something that you have said is important to you, you feel angry and stressed. It also means that it is unlikely you can fit in both of the things that were planned.
- I said we would need to leave at 9am but you have arrived at 9.45am
- I feel upset, angry and under pressure
- I want to be a good parent and being late means to me that I am failing but being late also means I end up under pressure
- Now that we are 45 minutes I do not think we can do what we had planned, I need help in deciding what to change. Do you have any thoughts?
Principle three - Maintaining boundaries
A constructive and collaborative style of communication does not mean that you now let others decide what happens. Particularly if you are clearly the one with the designated responsibility. The key concern now is finding a new plan that works for everyone - including you. With the example above you may decide to take out one of the activities that had been planned. Before you do this double check with your motivations to ensure that this is the most practical solution - that the decision is not an outlet for your difficult feelings but an answer to the dilemma you face. The message you want your children to have is that when things go badly in life it is important to take the course of action that best puts things back on track. And if you think some form of punishment is also necessary then that is a different issue and should be handled as such.
So you have said your piece and have invited help but it is now your decision to decide what should happen next. Clarity about who is in charge is ultimately about safety. If any of the children do not like your decision remind them of the fact that you are responsible and that in life it is important that people take their responsibilities seriously. And of course remind them that one day they will be in the position of responsibility and then they will need to be the one making the decision.
Our latest article on trauma, anxiety and the EU Referendum has been published today in the Chiswick Herald, please click here or read it below:
Traumatised by the EU referendum?
Last week Mark Carney, the Governor of the Bank of England said that the UK was already suffering from “economic post-traumatic stress disorder” or PTSD. Now in psychology this diagnosis is only applicable to people presenting symptoms once a month has passed since the traumatic event.
To consider the referendum as a traumatic event may seem exaggerated however it really does depend upon a persons relationship both to it and the perceived threat an unwanted outcome held. In our practice many people have wanted to talk about the EU referendum and the entire range of emotions have been triggered by an event that for many connects to key life concerns such as security, belonging, identity, relationships and hope for the future to name a few. I think many people have found that much of their time has been taken up or influenced by the referendum and if you have too then I think now is a good time to consider how you are coping.
Specifically, take some time to think about whether you have started to change how you are living on a day to day basis. Has how you experience or spend your days changed? Are you spending more time following the news / social media, are all your relationships as they were before, are you eating and exercising or have you slipped into some bad habits?
If the answer to any of these is yes then the key is regaining balance. If you are doing things that add to your stress and anxiety levels then either think about reducing the negative activities or add in other positive things to counteract the effects. This is important because if you do not take corrective action then you could end up with a stress or anxiety disorder.
I would however also like to take this opportunity to talk about PTSD as it was the starting point for this article. Having worked with patients diagnosed with this devastating condition for many years, including five years working with survivors of torture for a specialist charity in London, I think there is a growing confusion around trauma and how it impacts on people. I’m not suggesting the referendum will or will not result in cases of PTSD however we know that at times of particular stress and anxiety its also possible for PTSD related to previously untreated traumas to surface. So here is what you need to know about trauma.
Triggers for trauma are identified as exposure to actual or threatened death, serious injury or sexual violation and the person will have directly experienced the event, witnessed it, learnt of it in relation to a close family member or friend or, have been exposed to the details of the event.
Faced with a traumatic incident it is normal for a persons survival instincts to activate, so “fight, flight or fright” are the primary physiological responses combined with difficult thoughts, feelings and bodily sensations. However it is the symptoms that present following the event which are used to consider whether someone may need treatment.
In the weeks immediately following a traumatic event it would be usual to diagnose an Acute Stress Disorder or ASD. Sufferers with ASD will have the same symptoms as those with PTSD but not everyone who suffers a trauma and ASD will go on to have PTSD.
The symptoms are grouped into four clusters and include reliving the event (in dreams or through flashbacks), having distressing memories, thoughts or feelings as reminders of the event, then a range of cognitive experiences including memory loss, distorted thinking, wanting isolation and finally “arousal”. So being hyper vigilant, experiencing sleep problems and / or reckless or self destructive behaviour, one example might be use of alcohol.
In returning to the EU referendum it is still too early to consider the use of the term PTSD to that event however it is not too early to take stock to ensure you are managing your stress and anxiety. Stress, anxiety and post traumatic stress disorders are types of mental distress and illness where much work has been done to both understand and treat sufferers. Following a time of stress/anxiety/trauma it may well be possible for us to find our way back to a post event way of living but it can also trigger an anxiety / post traumatic stress disorder particularly if there were already other underlying concerns in life or previous untreated trauma.
Here is our latest article from the Chiswick Herald reviewing a Yoga retreat and Yoga approach. Please read below or see it here on the Chiswick Herald site.
Moving from the couch to the yoga mat
Many of my patients are often already practicing or take up “physical” activities such as Pilates, Tai Chi, Qigong or Yoga. Over the years I’ve tried yoga on a number of occasions but not been able to find one that I’ve wanted to continue. So when I heard of a form of yoga where the underlying assumption is about uncovering or more accurately rediscovering the innate expertise we have to live a healthier life, an association I make with therapy - I wanted to explore further.
Fairlie Gibson teaches this yoga in London but also runs holidays to teach this approach, she told me “the yoga holidays I offer are based upon an approach practiced and shared by Vanda Scaravelli. Vanda didn’t want to give her style a new name but it has become known as Scaravelli inspired yoga. We set the holidays in either beautiful mountainous Andalucia or on the gorgeous turquois coast on Southern Turkey. The aim of these holidays is give the participants, no matter what their experience of yoga, the chance to experience this, as yet, little known approach”.
By way of some background and before I talk more about the potential interplay and complementarity of this yoga to therapy I want to go back in history as I think it provides some basic and helpful context. The word disease has its origins in 14c. coming from Old French desaise and it was an holistic term covering the experience of both physical and emotional distress. It is simply the opposite of ease so the experience of “dis”ease. As medical science has found treatable causes for many sources of distress the word disease has become associated primarily with the physical. With “ill at ease” being used instead of disease but also having the connotation of some minor discomfort. In the same way the word patient has its origin in patience meaning someone that endures pain and suffering.
The importance of all this is recognition that the physical and emotional are in fact inseparable. If you feel “dis-ease” then do see your doctor but remember that when you reach the limits of what current medical science can provide you will need to access your own resources to treat or manage any remaining “dis-ease.”
The relationship I build with patients aims to bring a sense of safety and relaxation as we spend time together. That sense of relaxation or comfort enabling us to look again at how life is being lived and identify misunderstandings, unhelpful thinking, unhelpful habits, automatic responses and physical actions that have become fixed when in reality in any given moment and in any situation a range of options will be available. In short our way of living or being that was helpful in the past may not be the most helpful now.
So now back to the yoga. The experience of many who have trained in yoga is the need to learn new moves, push the body, stretch to the limit in other words to add more instruction and to have to work harder – all at a time when they have been drawn to a physical activity because they want to make life better. Resulting struggles to achieve the pose, remember the sequences, to practice regularly combined with physical injury, negative thoughts and feelings can all lead to the exact opposite of what was hoped.
Scaravelli is known to have said “if you are kind to your body, it will respond in an incredible way”. My own experience of the yoga was first and foremost one of kindness, creating space, allowing, appreciating and only then to move the body in ways that are known to result in greater flexibility, strength and sense of well being.
Fairlie told me “It’s about coming home to yourself rather than learning something new or put another way, about unlearning and then being with ourselves in a different way”. She continued “We have become so absorbed in the need to achieve. In yoga visuals of practitioners bent double in seemingly impossible stances have resulted in a lot of pressure to achieve whereas it is more about experiencing freedom in the body. The pace of the practice is such that there is great emphasis on creating space and allowing time for the body to find its optimum”.
As the week progressed I found myself feeling very at ease in positions that felt wonderfully natural only to realize I was actually adopting positions that I would have anticipated requiring a huge amount of effort. I’m not saying it is easy, its not about whether its easy or hard its more about what can happen once you have let go of trying. Fairlie called this “effortless effort.” And I find myself concluding that the space this yoga creates and the freedom it generates to allow for change is indeed very therapeutic. This is a form of yoga I am interesting in continuing to practice.
Details of upcoming yoga holidays can be found on Fairlie’s website www.freeingthebody.com
Our latest article in the Chiswick Herald publishes today and is available online here.
Or read the article below:
Feeling lost? What happens if you think philosophically?
When I first meet people and I ask “How is it that you are here?” they often tell me they are feeling lost. The experience of feeling lost is one that can be so painful and confusing we naturally tend to look outside of ourselves for help in again finding a way forward. In other words we are no longer finding it possible to approach our situation philosophically.
In my view, our tendency to blame ourselves for having become lost feeds a sense of isolation and loneliness; one which helps prevent us from harnessing our innate abilities to again find our way. And of course any pattern of thinking that encourages us to think negatively will only escalate how bad we feel. We can feel sad about feeling sad, anxious about feeling anxious, confused by our confusion, lost in our lostness; I think you get the point.
To break the cycle we need to do something differently that results in us again feeling hopeful and enables us to again engage with our innate philosophical potential. After all, and to allow us a brief moment of philosophical thinking, to feel lost means that at some point we did not feel lost? And to approach philosophically the point at which this changed is where we will find the information we need to again find our way. But how? Firstly, we need to find a calm disposition and secondly foster a curiosity towards our situation.
When people come to see me it will become apparent very quickly as to whether meeting with me has the potential to be helpful; whether we can develop a therapeutic relationship. In the first session the single most important factor determining the potential outcome for us is how the person feels in spending that first fifty minutes with me. Do they feel relaxed, are they feeling free to speak openly to me, do they feel heard and understood by me? Is there a glimmer of hope that has surfaced as a result of us meeting? Are my questions or questions that are occurring in them encouraging them to think about things in a new way? The therapeutic relationship is the foundation of healing and often research has shown that for many, a relationship where the person has felt safe, cared for, heard and understood has been what has mattered most.
And as suggested earlier the second aspect of a philosophical approach is being able to think clearly about our situation. When young, we quickly learn through the use and questioning of the information our senses provide. Our thoughts, feelings and bodily sensations are converted into information that enables us to understand the world when we also ask when? where? who? what? how? and why? And this learning forms the basis of how we make decisions. As we go through life we will automatically respond to situations that we understand as familiar bypassing any great contemplation of our senses or any rigorous questioning.
This all works fine until the situations are in fact not similar enough that an automatic response is the best choice. Our context may have changed, and/or we may have changed, either way a response that always used to result in a positive outcome is resulting in a negative outcome. We try again and again and that only leads to us feeling worse until we realise we are lost. What we missed at the moment when our choice did not provide the outcome we expected was the need to remember that everything changes. And with change comes the need for us to be prepared to accept that the things we have come to expect as certain may need us to revisit them.
The ease with which we can do this alone depends upon many things but I think that if you are not finding a way to feel calm and that as a result you may not be finding it possible to think clearly then do not punish yourself for feeling this way. Be as kind and compassionate as you would be to the person you care for most in life. After all, surely you would tell them that they deserve help, that it is ok to sometimes need to seek help, that they do not need to feel alone? And once you no longer feel alone and you are again able to access the full potential of your curiosity you will again find your way.
Notes about Nicholas:
Nicholas is registered as a Psychotherapist with the United Kingdom Council for Psychotherapy through the Society of Existential Analysis following a training that applies philosophical enquiry to concerns that are often brought to counsellors and psychotherapists. This particular approach to therapy combines the therapists wish to alleviate the suffering of others with a framework borne from existentialism and phenomenology.
Our latest article published in the Chiswick Herald and Chiswick Herald Magazine invites readers to write in with their dilemmas. Read the article below:
If you have a question you would like to put to us please write in and we will consider your question and respond to it in the next edition of the Chiswick Herald Magazine. When we publish the question we will not give any of your details - merely print the question and our response. Send us your question by email to firstname.lastname@example.org or in writing to Nicholas Rose, Nicholas Rose & Associates, The Cove Spa, 300-302 Chiswick High Road, W4 1NP.
Meanwhile, for this edition I’ve pulled together a list of the top questions people ask us about counselling and psychotherapy.
Q. What is the difference between counselling and psychotherapy?
The terms Counselling and Psychotherapy, these are often used interchangeably. However for the purposes of understanding what to expect, counselling is an endeavour that often has a clearer focus than psychotherapy for example a Bereavement or particular crisis. The nature of more clearly de ned concerns tends to result in a limited number of sessions.
Psychotherapy is relevant where there is a sense of struggle without any particular sense of a cause of the concern, often this struggle is something which has been experienced for a considerable period of time. A psychotherapy relationship tends to be of a longer-term nature.
Q. How does counselling or psychotherapy work?
Counselling & psychotherapy with us provides an opportunity to develop a greater understand- ing of your dif culties, to comprehend and clarify what was previously unclear and with this new awareness to identify and implement changes in your life. Crucially we offer a sup- portive relationship until the point at which you feel your dif culties have been addressed.
Q. How many sessions will I need?
It is never possible to say at the start how many sessions will be needed however it is usual to regularly review how your sessions are going and ensure you are nding them helpful.
Q. Will I have to lie on a couch?
The patients of psychoanalysts may well lie on a couch during sessions. But the many thera- pists will arrange the room so you sit in chairs.
Q. How do I choose the right counsellor or psychotherapist?
A great deal of research has and is being under- taken on the subject of Counselling Services, Psychotherapy Services and the different ap- proaches to therapy. It suggests that the most important factor in effective outcomes is the strength of the relationship between the client and the counsellor or psychotherapist. We al- ways suggest you meet a therapist for an initial session and then you can decide whether you feel comfortable, useful questions to ask your- self are: do I feel listened to and understood? Is it easy for me to speak to this person or are there things I am not saying?
Q. If I want a male, female, straight, bisexual or gay therapist is it ok to ask for that?
Of course, the priority is that you feel com- fortable. Having said that if you do not feel comfortable then it can be really helpful to ask yourself why that might be? Is it possible that the way you feel about the therapist is connected to the concerns you are bringing to therapy? If so maybe you have found the right therapist for you after all.
Q. How does couples counselling work?
Couples counsellors aim to provide a warm, supportive and non-judgmental environment, and do not take sides. Couples counsellors do not come to the sessions with an agenda; they are not there to tell you what to do or to manipulate you into staying together. They are there to facilitate you in nding your own way forward; for some couples this will mean nding a more creative and positive future for the relationship, while for others it may mean helping you to accept and manage the end of a relationship.
Q. What is family therapy?
Family therapy enables family members to listen, respect and understand different per- spectives and views, to appreciate each other’s needs and to build on their strengths to make useful changes and nd positive ways forward.
Q. Will I have to talk about my parents?
It is your space to talk about what you choose however a therapist might ask questions if they maybe relevant to the issues you want to explore. Ultimately you decide on what you want to talk about, having said that if you nd there is something that you are not saying it can be really helpful to ask yourself why!
Q. What is Child Psychotherapy?
Child Psychotherapists work with children by building a relationship through talking, play or the use of art materials to help children express themselves and help them to resolve issues concerning them. A space and time is created for them to think about life, to talk about growing up, about what happens at school with friends and about what it is like to be them. A child psychotherapist can also offer a great deal of support for parents and families at times of struggle.
Q. When can a child psychotherapist be help- ful?
If a child is showing signs of distress at home or school or if as a parent/s you are struggling in your relationship with your child. In addition there are a number of particular dif culties which can helpfully be brought to a child psychotherapist including pre and post natal dif culties, birth trauma, aggressive behaviours, ADHD, autism, divorce and separation, adop- tion, bereavement and loss, eating disorders, separation anxiety, selective mutism, obsessive behaviours. self harm.
We look forward to hearing from you
This article is the second in a series by Nicholas reviewing an online Mindfulness Training he started just prior to Christmas.....
I hope you had a peaceful, relaxing and enjoyable Christmas?
For my part a quiet Christmas with close friends and family has been a healing experience after three successive festive seasons with various painful, stressful situations and losses. Periods of calm, gentle relaxation with others who have been easy company, has been nurturing, restorative and facilitated a general sense of well being.
Alongside this and the absence of any new difficulties, has also been the Online Mindfulness Training I’ve been doing as introduced in the last column published in the paper on the 17th December or available here online: http://chiswickherald.co.uk/on-the-couch-with-nicholas-rose-p4693-261.htm. The training itself is provided by www.bemindfulonline.org.
Overall, both have given me an experience of a period of time whereby the noticeable absence of worries again suggests to me just how much previously experienced day to day stress and anxiety maybe coming from nothing other than self made pressures. Of course it is natural to react to difficult situations by taking action and making lists of things to do, however a list of things will only bring additional pressure and a resulting bodily response that adds to the already heightened experience caused by existing difficulties.
As is always the case when I spend time practicing and learning more about Mindfulness I find something new and helpful that makes the time spent both easier and more rewarding. As I start week three of the training it is during a meditation I notice throbbing in my head, it is something I’ve noticed many times before. Previously I’ve tried doing what I’ve been taught, namely paying it attention but the outcome has been for me to feel somewhat nauseous and it has led me to feel reluctant at times to practice. However this time, right at the moment when the nausea is starting to appear the facilitator, Ed, says something like “if you notice any unpleasant thoughts, feelings or bodily sensations you can try paying them attention or you might find it helpful to return your focus to your breathing". This I do and the pain and nausea disappears. Todays learning was a piece of “unlearning” - I had been holding an assumption that there was only one way to deal with difficult experiences during mediation but now these few words have released me from something that was certainly unhelpful.
And I am finding Ed and Tessa, the facilitators, to be perfect companions to the training. In the middle of the second week just at the point I noticed thoughts around how the training was not enough I received an email inviting me to a mid week video. It was as though they knew exactly how I would be thinking and feeling at this stage and hearing them talk about the successes and challenges of the exercises as I had also experienced of them was just what I needed. I was left feeling reassured that I was in fact on course, not alone in my experience of suddenly doubting whether the training was useful and not failing.
This week I read two articles published on washingtonpost.com about Mindfulness, one from Neuroscientists again talking about how after eight weeks of practicing, changes to the brain can be seen in areas that they believe are helpful and healthy, meanwhile another article warns that Mindfulness is being “mindlessly” taken up by everyone when for some people it might not be helpful - in fact it might be unhelpful.
Mindfulness helps me to identify where stress and anxiety is leading me to do more than I need to, whether that is working, cleaning, eating, drinking, exercising, resting or like this week, paying attention to difficult experiences during a meditation. In other words it helps me to keep things in perspective and this is what I believe is most helpful. As a psychotherapist I’ve learnt and experienced many different approaches to gaining perspective but when I think of things that I have found helpful I would say that both therapy and mindfulness as it is taught and practiced today have been the most useful.
I’m still working through the Online Training so I will let you know in the next column what I think as I reach the end.
Our latest article has been published in the Chiswick Herald, please click here. Or read it below:
Wishing you all a very mindful Christmas
When I was thinking about what to write for this column I decided to search the internet for “mental health news and Christmas”. The search results displayed many features on how to manage stress over the festive period and I felt discouraged. It seems that Christmas and the New Year are often only really considered for the struggles they bring rather than the potential for reflection, contemplation, love, fun, connection, relaxation and self expression. What did catch my eye though were the many references to Mindfulness and through the website for the Mental Health Foundation I came across an online training course in Mindfulness.
Mindfulness is something I know quite a lot about having started meditating nearly twenty years ago and have always found the more mindful based practices the most helpful. I have also enjoyed retreats and trainings to develop my practice and yet it is at times when I could most benefit from mindfulness that I can so easily end up doing other, arguably less helpful things with my time. And this Christmas is a difficult one for me, it is a year on since the death of someone very important to me and so naturally, as the anniversary comes closer, then I find myself experiencing difficult emotions and thoughts. My body is also showing me that it is a hard time, a cold, tense neck and shoulders muscles a few headaches and occasional sore tummy. So now really is the time for me to be particularly kind to myself and to call upon my mindfulness practice - yet the turbulence I am experiencing also makes this hard to do. I think this explains why this online training has attracted my attention and so I’ve decided that for the next few columns I am going to take the training and then share the experience.
The background information from the provider of this training, a website called www.bemindfulonline.org, states research conducted by Oxford University published in the BMJ (British Medical Journal) reported 58% reductions in anxiety, 57% in depression and 40% in stress; so I feel excited and hopeful thinking about getting started. If you sign up you get free access to a short introductory video from the two Trainers Ed and Tessa. Watching this I find the trainers very reassuring, with what they say resonating easily with my experience of mindfulness. And I find I am really warming to this as an approach to learning, you can take this at your own speed.
Next is a short video introducing a pre-training test. In this Ed explains it will benchmark how you are experiencing and relating to stress to allow for comparison at the end of the course. Taking the test, I recognise the questions that are widely used to form generic tests for stress, anxiety and depression. As I complete the tests I am struck by how the last two weeks have been particularly hard for me and I am again drawn back to thoughts around the events and memories from the run up to my bereavement last year. A further video from Tessa acts to again reassure but also encourage continuing with the course. At this point though the free introductory element comes to an end and a fee of £60 needs to be paid before you can continue. I’m feeling curious so I find it easy to make the payment.
It feels good to be getting properly started and the first exercise is one I’ve done before - they call it mindful eating. What really strikes me is how distracted I am, how hard it is to focus and my awareness of this I find reassuring. I’m already starting to gain a sense of empowerment, I’m thinking I’m on to something that is really going to help me at this time. Pressing the play button again Ed and Tessa now introduce the tasks for week one. Again they are exercises I’ve done before but in hearing what I will be doing I start to feel more relaxed. I’m thinking it is as though I am being allowed to slow down, to go at my own speed. It is a bit like having someone who really really trust ask you what you want to do and then to have them give you reassurance that you really do know best!
So what will I be doing each day for the next week? The tasks are as follows firstly to eat a meal mindfully, secondly choose a daily task for the mindful treatment - mine will be cleaning my teeth and lastly a thirty minute guided mindfulness relaxation. It is going to be a busy time over the next week as I prepare for the Christmas break so I’m going to need a bit of will power. By the next time I write I will be able to tell you how it has been and what exercises were introduced for the second week. In the meantime from all of us here at Nicholas Rose and Associates we wish you all the very best for a mindful and enjoyable Christmas and New Year.